DeVore Greggory R, Satou Gary, Sklansky Mark, Cuneo Bettina
Fetal Diagnostic Centers of Pasadena, Tarzana, and Lancaster, Pasadena, California, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Echocardiography. 2023 Mar;40(3):204-216. doi: 10.1111/echo.15533. Epub 2023 Feb 2.
Speckle tracking analysis was used to evaluate right (RA) and left (LA) atria size, shape and contractility to create a probability calculator to identify fetuses at risk for urgent neonatal balloon atrial septostomy (BAS).
The study group consisted of 39 fetuses with D-TGA, of which 55% (N = 22) required neonatal BAS and 45% (N = 17) did not. The RA and LA end-diastolic areas, lengths, widths, and sphericity indices as well as global, longitudinal, and transverse contractility were measured with speckle tracking analysis. The z-scores of the measurements were compared to 200 controls. Logistic regression analysis of the computed z-score measurements was performed to separate fetuses requiring urgent neonatal atrial BAS from those who did not.
The following z-score values for all fetuses with D-TGA, irrespective of whether they required neonatal BAS, that were significantly less than controls: RA base sphericity index, basal-apical length fractional shortening, fractional area change, lateral wall annular plane systolic excursion (APSE), and longitudinal reservoir strain; LA mid-chamber width, fractional shortening, ejection fraction, basal-apical length fractional shortening, atrial ejection volume, septal wall APSE, and reservoir strain. The following z-score values were significantly larger than control values: RA/LA mid-chamber width, RA/LA base width, and RA mid-chamber length. Logistic regression analysis identified the following five measurements that correctly identified 19 of 22 fetuses requiring urgent neonatal atrial BAS with a sensitivity of 86.4%, a false-positive rate of 11.8% and a positive predictive value of 90.4%: (1) LA mid-chamber transverse fractional shortening, (2) RA mid-chamber end-diastolic width, (3) RA basal-apical length fractional shortening, (4) RA mid-chamber fractional shortening, and (5) RA fractional area change.
Using the measurements described in this study identified significant differences between all fetuses with D-TGA and controls, as well as identified measurements that predicted the probability of D-TGA fetuses requiring neonatal septostomy.
采用斑点追踪分析评估右心房（RA）和左心房（LA）的大小、形状及收缩性，以创建一个概率计算器，用于识别有紧急新生儿球囊房间隔造口术（BAS）风险的胎儿。
研究组包括39例患有完全性大动脉转位（D-TGA）的胎儿，其中55%（N = 22）需要新生儿BAS，45%（N = 17）不需要。采用斑点追踪分析测量RA和LA的舒张末期面积、长度、宽度、球形指数以及整体、纵向和横向收缩性。将测量的z值与200例对照进行比较。对计算出的z值测量结果进行逻辑回归分析，以区分需要紧急新生儿房间隔BAS的胎儿和不需要的胎儿。
所有患有D-TGA的胎儿，无论是否需要新生儿BAS，以下z值均显著低于对照组：RA基部球形指数、基底部至心尖长度缩短分数、面积变化分数、侧壁环形平面收缩期位移（APSE）和纵向储备应变；LA房中部宽度、缩短分数、射血分数、基底部至心尖长度缩短分数、心房射血容积、间隔壁APSE和储备应变。以下z值显著高于对照值：RA/LA房中部宽度、RA/LA基部宽度和RA房中部长度。逻辑回归分析确定了以下五项测量指标，可正确识别22例需要紧急新生儿房间隔BAS的胎儿中的19例，灵敏度为86.4%，假阳性率为11.8%，阳性预测值为90.4%：（1）LA房中部横向缩短分数，（2）RA房中部舒张末期宽度，（3）RA基底部至心尖长度缩短分数，（4）RA房中部缩短分数，（5）RA面积变化分数。
使用本研究中描述的测量方法可发现所有患有D-TGA的胎儿与对照组之间存在显著差异，同时还可确定预测D-TGA胎儿需要新生儿房间隔造口术概率的测量指标。
